EAL

NNNS: Adverse Effects (2011)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

This article reviews and discusses the current literature for correlations between the lifestyle and urological malignancies, (including physical activity, artificial sweeteners, alcohol consumption and smoking) and genitourinary tumours.

Inclusion Criteria:

Epidemiological studies had to be cohort or case-control studies.

Exclusion Criteria:

If an author published several papers based on the same study, only data from the most recent publication were included.

Description of Study Protocol:

A Medline search was conducted and covered the period from 1970 to 2002. This screening was supplemented by manually searching for all references from retrieved articles.

Data Collection Summary:

Description of Actual Data Sample:

Summary of Results:

All relevant studies carried out to date on the cancer risk associated with sweetener consumption are summarized in the table.

Studies on Cancer Risk Associated with Human Artificial Sweetener Consumption
Study Design	N	Sweetener	Parameter Investigated	Results and RR	Comments	Literature
Case-control	1,860	Not defined (various sweeteners and combination thereof)	Bladder cancer risk	RR (relative risk)=1.3 for heavy consumption	None	Stureon et al, 1994
Case-control	217	Saccharine	Bladder cancer risk	RR=3.9	Study has questionable value	Yu et al, 1997
Case-control	367	Not defined	Bladder cancer risk	No statistically significant increased risk; RR=0.8	None	Wynder et al, 1980
Case-control	217	Saccharine	Bladder cancer risk	No statistically significant increased risk; RR=1.3	None	Najem et al, 1982
Case-control	1,128	Not defined	Bladder cancer risk	RR (men)=0.8 RR (women)=1.6	None	Morrison, Buring, 1980
Descriptive	no statistically increased risk	Saccharine	Bladder cancer mortality	No statistically significant increased risk	Observation of mortality and saccharine intake in England	Armstrong, Doll, 1974
Case-control	525	Cyclamate	Bladder cancer risk	No statistically significant increased RR=1.2	None	Simon et al, 1975
Case-control	1,038	Not defined	Bladder cancer risk	No statistically significant increased risk; men=1.1, women=0.8	None	Kessler, Clark, 1978
Case-control	1,618	Not defined	Bladder cancer risk	No statistically significant increased risk; men=0.95, women=1.15	None	Risch et al, 1988

Author Conclusion:

The correlation between the consumption of artificial sweeteners and genitourinary tumor incidence remains a matter of controversial discussion
In consideration of the data available, a significant contribution to the development of genitourinary tumors is unlikely.

Funding Source:

Not-for-profit

Foundation associated with industry:

Reviewer Comments:

Quality Criteria Checklist: Review Articles
Relevance Questions
	1.	Will the answer if true, have a direct bearing on the health of patients?	Yes
	2.	Is the outcome or topic something that patients/clients/population groups would care about?	Yes
	3.	Is the problem addressed in the review one that is relevant to dietetics practice?	Yes
	4.	Will the information, if true, require a change in practice?	N/A

Validity Questions
	1.	Was the question for the review clearly focused and appropriate?	Yes
	2.	Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?	N/A
	3.	Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?	No
	4.	Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?	No
	5.	Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?	Yes
	6.	Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?	Yes
	7.	Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?	No
	8.	Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?	Yes
	9.	Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?	No
	10.	Was bias due to the review's funding or sponsorship unlikely?	Yes